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SAN DIEGO — A CDC panel is now recommending most Americans receive the Pfizer and Moderna COVID-19 vaccines over the Johnson & Johnson option.

The panel weighed the risk and effectiveness of each shot, determining the extremely rare blood clot issue caused by the J&J shot was serious enough to favor the other two vaccines.

“Early on in the pandemic, we didn’t have enough vaccines to go around, so we looked at the risk and the benefit and said, ‘Get any vaccine you can get,’” explained San Diego infectious disease expert Dr. Mark Sawyer.

A CDC panel released the new vaccine recommendation Thursday.

Dr. Sawyer says the blood clots only happen three-to-four times out of every million doses. The chances are low, but the complication has caused about nine deaths. Compared to the data on side effects from Pfizer or Moderna, and evidence that those two shots are more effective, J&J fell behind its competitors in the eyes of the panel.

“We’ve talked a lot about myocarditis as a complication of mRNA vaccines, but as we have given millions of doses of these vaccines, we have learned that although they can cause myocarditis, it’s very mild and nobody has died from that side effect,” said Dr. Sawyer, referring to a condition that causes inflamation in the middle layer of the heart wall.

Still, Dr. Sawyer stands by the J&J shot as an option, particularly for hard-to-reach parts of the population, like people who are homeless, who may not go back for a needed second dose.

“If it’s the only vaccine you can get, it’s still a better idea to get it. People who are unvaccinated are in much greater risk all-around than people who are vaccinated, including the side effects from the vaccine.”

The CDC’s director must now decide whether to accept this panel’s advice, which should happen in the next few days.